Managing Hand Pain: Solutions for Carpal Tunnel and Trigger Finger

Hand problems

Hello, Doctor: I have previously experienced carpal tunnel syndrome.
I used the smallest pillow and often slept with my hands as a pillow at night.
Additionally, when I used to sleep on my stomach, I would rest my hands underneath me.
Later, while working in a rice ball factory, I had to use my hands frequently and lift heavy items (35 kg), which led to numbness, pain, and weakness in both hands (particularly in the palms and wrists).
After consulting a physician, I was diagnosed with carpal tunnel syndrome.
I underwent tests on both hands and an electromyography (EMG) examination, which showed slow responses, as the doctor mentioned.
I especially felt discomfort in my hands while riding a motorcycle! Furthermore, my right ring finger was previously sprained, which has caused it to bend like trigger finger; I often need to use my left hand to straighten it, and doing so is very painful, especially at the joint near the palm! After straightening it, the pain subsides somewhat.
My father may have also experienced trigger finger, but I am not a doctor and he never described his symptoms to me.
However, after visiting the doctor a few times, he recovered! I wonder if trigger finger is hereditary? Additionally, I have a history of neck injuries and scoliosis, which might also contribute to my hand numbness!? I have seen videos online about the introduction and treatment of carpal tunnel syndrome, but I have not yet watched any regarding trigger finger! In one video, there was a type of electrical therapy device mentioned, but it did not specify the model.
It had both heat and electrical therapy functions and introduced rehabilitation using items like rubber bands.
Generally speaking, rehabilitation devices only have electrical therapy functions without the heat function.
Each time I do rehabilitation, I apply the therapy to the painful areas, so could I buy a low-frequency electrical therapy device to use at home? Also, since carpal tunnel syndrome is caused by improper or excessive use of the hands, wouldn’t stretching with rubber bands or soaking in warm water for finger exercises lead to even more hand usage? I have tried this in a hot spring; although it felt comfortable immediately, the symptoms of carpal tunnel syndrome and trigger finger returned quickly, and the effects were not as long-lasting as rehabilitation! However, rehabilitation is very slow and time-consuming! Dr.
Yang mentioned making a splint for me, but I refused because I need to work every day and don’t have time for ice therapy! He also said I would need an injection for my trigger finger.
I am very scared! I really do not want to undergo surgery or get an injection because if it doesn’t work or if my hand becomes worse, it would be a loss! I also cannot find a job that doesn’t require using my hands.
Additionally, since I sleep on my side, I am unsure where my body might be having issues.
Currently, my carpal tunnel syndrome has improved a bit, but the trigger finger causes me daily suffering, approaching a severe level! What should I do? I want to treat this in a reversible and safe manner; what options do I have? Thank you very much!

Jason, 30~39 year old female. Ask Date: 2019/01/18

Dr. Yin Xinbei reply Rehabilitation

If you are unwilling to receive injections or surgery and do not have time for long-term rehabilitation, and if your current symptoms of carpal tunnel syndrome are tolerable, you can apply heat to your wrist and hand or soak them in warm water.
At the same time, avoid actions that put pressure on the wrist and excessive joint movement.
It is still recommended to wear a splint, even if it is inconvenient at work; it should be worn during sleep as well to alleviate numbness in the hands during the night or early morning.
When sleeping, avoid putting pressure on the wrist; if changing positions is not possible, consider using pillows and mattresses made of memory foam, which will not exert pressure on the affected area even if compressed.
However, if carpal tunnel syndrome is left untreated, the consequences can be more severe than trigger finger, as it may lead to permanent nerve damage and muscle atrophy.
Therefore, it is advised that if you notice weakness in your hand or a decrease in the size of the muscles below your thumb, you should seek medical attention immediately.

As for trigger finger, if injections and surgery are not options, it can be challenging to manage, especially for patients with chronic conditions where the tendon sheath has tightened due to chronic inflammation.
At home, aside from applying heat and stretching (referring specifically to the fingers, not the wrist, so it won't affect carpal tunnel syndrome), you can only use analgesic and anti-inflammatory ointments to massage the tendon sheath of the fingers to relieve pain.
If there is no improvement, surgical treatment should still be considered.

Lastly, it needs to be clarified that regarding the statement, "rehabilitation only has electrical therapy functions and lacks a combination of thermal functions in the electrical therapy device.
Moreover, during each rehabilitation session, the treatment is applied only to the painful area," even in rehabilitation clinics, there are typically more than just electrical therapy devices.
Other deep heat therapies, such as ultrasound or laser therapy, are also employed to address the symptoms of carpal tunnel syndrome or trigger finger.

Reply Date: 2019/01/18

More Info

Managing hand pain, particularly conditions like carpal tunnel syndrome and trigger finger, can be quite challenging, especially when they interfere with daily activities and hobbies such as playing the guitar. Based on your description, it seems you are dealing with multiple issues that may be interconnected, including carpal tunnel syndrome, trigger finger, and possibly the effects of previous injuries.

Understanding Carpal Tunnel Syndrome and Trigger Finger
Carpal Tunnel Syndrome (CTS) occurs when the median nerve, which runs through the wrist, becomes compressed. This can lead to symptoms such as numbness, tingling, and pain in the hand and fingers, particularly when using the hands for repetitive tasks. Factors contributing to CTS include wrist position during sleep, repetitive hand movements, and even underlying conditions such as diabetes or thyroid issues.

Trigger Finger, on the other hand, is characterized by the locking or catching of a finger when it is bent. This condition arises from inflammation of the tendons that control finger movement, often exacerbated by repetitive gripping or grasping motions. The pain you experience when trying to straighten your finger is a classic symptom of trigger finger.

Treatment Options
1. Rest and Activity Modification: One of the most effective ways to manage both conditions is to rest your hands and modify activities that exacerbate symptoms. Since you mentioned that your work involves heavy lifting and repetitive hand use, it may be beneficial to explore ways to reduce strain on your hands. If possible, consider delegating tasks that require heavy lifting or frequent hand use.

2. Ergonomic Adjustments: Evaluate your workspace and sleeping position. Using a supportive wrist brace at night can help keep your wrist in a neutral position, reducing pressure on the median nerve. During the day, ensure that your workstation is ergonomically set up to minimize strain on your wrists and hands.

3. Physical Therapy: Engaging in physical therapy can be highly beneficial. A physical therapist can provide tailored exercises to strengthen the muscles in your hands and wrists, improve flexibility, and reduce pain. They may also use modalities such as ultrasound or electrical stimulation to alleviate pain and promote healing.

4. Stretching and Strengthening Exercises: Gentle stretching and strengthening exercises can help maintain flexibility and strength in your hands. For carpal tunnel syndrome, wrist flexor and extensor stretches can be particularly helpful. For trigger finger, finger flexor stretches can aid in reducing stiffness.

5. Heat and Cold Therapy: Applying heat can help relax and loosen tissues and stimulate blood flow to the area. Cold therapy can reduce inflammation and numb sharp pain. Alternating between heat and cold may provide relief.

6. Medications: Over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen, can help manage pain and inflammation. If symptoms persist, your doctor may recommend corticosteroid injections to reduce inflammation in the affected areas.

7. Alternative Therapies: Some individuals find relief through acupuncture or chiropractic care. These therapies can help alleviate pain and improve function, although more research is needed to establish their efficacy for these specific conditions.

8. Surgical Options: If conservative treatments fail and symptoms significantly impact your quality of life, surgical options may be considered. For carpal tunnel syndrome, surgery involves releasing the pressure on the median nerve. For trigger finger, a procedure to release the tendon sheath may be performed. However, these options should be discussed thoroughly with your healthcare provider, considering your fears and concerns about surgery.

Conclusion
It's crucial to communicate openly with your healthcare provider about your symptoms, treatment preferences, and concerns regarding injections or surgery. They can help you develop a comprehensive treatment plan that aligns with your lifestyle and goals. Remember, managing these conditions often requires a multifaceted approach, combining rest, therapy, and possibly medication, to achieve the best outcomes. Prioritizing your hand health will ultimately allow you to return to activities you enjoy, like playing the guitar, with greater comfort and ease.

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